Provider Demographics
NPI:1508148230
Name:RHOADES, JIMMY H (RPH)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:H
Last Name:RHOADES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S CREASY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-0749
Mailing Address - Country:US
Mailing Address - Phone:765-448-3517
Mailing Address - Fax:765-448-3549
Practice Address - Street 1:130 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0749
Practice Address - Country:US
Practice Address - Phone:765-448-3517
Practice Address - Fax:765-448-3549
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017452A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist